BENIGN PAROXYSMAL POSITIONAL VERTIGO

BENIGN PAROXYSMAL POSITIONAL
VERTIGO
Timothy C. Hain, MD
In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due
to debris which has collected within a part of the inner ear.

This debris can be thought
of as "ear rocks", although the formal name is "otoconia". Ear rocks are small crystals of
calcium carbonate derived from a structure in the ear called the "utricle" (figure1). While
the saccule also contains otoconia, they are not able to migrate into the canal system. The
utricle may have been damaged by head injury, infection, or other disorder of the inner
ear, or may have degenerated
because of advanced age.).
BPPV is a common cause of dizziness. About 20% of all dizziness is due to BPPV. While
BPPV can occur in children (Uneri and Turkdogan, 2003), the older you are, the more
likely it is that your dizziness is due to BPPV. About 50%
of all dizziness in older people
is due to BPPV. In a recent study, 9% of a group of urban dwelling elders were found to
have undiagnosed BPPV (Oghalai et al., 2000).
The symptoms of BPPV include dizziness or vertigo, lightheadedness, imbalance, and
nausea. Activities which bring on symptoms will vary among persons, but symptoms are
almost always precipitated by a change of position of the head with respect to gravity.
Getting out of bed and rolling over in bed are common "problem" motions. Because
people with BPPV often feel dizzy and unsteady when they tip their heads back to look
up, sometimes BPPV is called "top shelf vertigo." Women with BPPV may find that the
use of shampoo bowls in beauty parlors brings on symptoms. A Yoga posture called the
"down dog", or Pilates is sometimes the trigger. An intermittent pattern is common.
BPPV may be present for a few weeks, then stop, and then come back again.
WHAT CAUSES BPPV?
The most common cause of BPPV in people under age 50 is
head injury .